My last two blog posts have explained IMHO the two reasons why we don’t use forensic drug testing: the cost and that we don’t actually believe addiction is a disease, despite that we say we do. You can read them here: https://4csofaddiction.com/2024/02/22/ask-and-it-shall-be-answered/ and https://4csofaddiction.com/2024/02/29/and-another-thing/
My niece L recently pointed out to me that 1 in 7 people with HIV don’t know they have it (https://health.gov/myhealthfinder/health-conditions/hiv-and-other-stds/get-tested-hiv#). I facetiously replied that 1 in 2 people don’t know they have the disease of addiction. “Don’t know or don’t want to admit?” she asked.
And here’s the rub: how would they KNOW? Who’s telling them? Friends and family have to be at the ends of their ropes to even point out a problem, and even then they rarely say anything. If they did, the sick person would say, “Who are you to tell me? You’re not a professional!”
And those professionals…? They aren’t telling them, either!
The professionals can’t identify it.
The professionals aren’t screening for it.
The professionals don’t want to seem judgey.
The professionals don’t want the person to look elsewhere for services.
Take your pick. It comes down to the fact that, while we SAY we believe that addiction is a disease, we don’t really believe that it is.
My sister has diabetes; my friend has cancer; my husband has heart disease. No professionals would ever tell them that they can continue doing what they’ve always done because the professionals don’t want my loved ones to feel bad about themselves or because saying something would ruin their chances at getting treatment, but how many times do we hear these excuses about those with addictions?
So, the surefire way to determine addiction – which is direct biomarker testing – has become a “gotcha!” It’s rarely used to help someone determine that substances are causing negative outcomes. Rather, a positive test warrants a negative consequence. This is not to say that negative actions don’t deserve negative consequences. They absolutely do…and those actions and consequences should be considered separate from the disease.
- A person is told not to use substances by his probation agent; the agent tests; the results are positive; the person gets incarcerated for a brief period of time.
- An employer suspects an employee is using on the job; the employer tests; the results are positive; the employee is fired.
- A mother presents to give birth to her child after having no prenatal care; the hospital tests; the results are positive; the baby is taken into protective custody.
The number one cause of pregnancy-related deaths in the US is mental health conditions, which includes overdose and poisoning related to substance use disorders. This occurs in approximately 23% of deaths nationwide. (CDC). In Illinois, substance use disorder was the leading cause of pregnancy-related deaths from 2018 to 2020 (DPH). It was the same in Indiana in 2018: “Substance use disorder was the most common contributing factor to maternal deaths, likely contributing to over half of all pregnancy-associated deaths in 2018.” (IN.gov)
Negative outcomes for positive test results, but that shouldn’t be the case. A positive test should warrant an intervention, especially when another life is affected, as it is with testing neonates. Study after study shows that fetal protection laws don’t work…because those laws don’t treat addiction as the disease we know it is.
Don’t get me wrong: I am ALL for protecting fetuses, but those fetuses are attached to another living human being, and so we cannot protect the fetus without helping the mother – and we should stop trying to – because addiction is a disease. We don’t criminalize those with diabetes when the effects of their uncontrolled disease cause their babies to be stillborn, as we know it can (MEDLINE); we try to help them. We similarly don’t criminalize those who have babies after cancer diagnoses and treatment, even though those babies “are at risk for lower verbal IQ and visuospatial long-term memory scores and for higher diastolic blood pressure than matched controls.” (NCBI)
Why aren’t we punitive in response to these diseases but we remain so for the disease of addiction? Could it possibly be that it’s because we accept that diabetes and cancer are diseases, but, while professionals give addiction the lip service of being a disease, we really don’t believe it is?
Having babies when the mother suffers from a disease can lead to negative outcomes. We know this to be true. So how do we help instead of punish? We have to identify the disease…in this instance that of addiction. We know that pregnant people are dying because of their substance use disorders, and we absolutely know how to help! If only there were a way to identify the problem. Gosh…
But wait! There is! Perform direct biomarker tests on the individual most affected, the neonate. For the following reasons, umbilical cord tissue testing should be recognized as the gold standard of testing to determine if a baby is negatively affected by a birthing parent’s substance use during pregnancy:
- “Umbilical cord tissue belongs to the baby, so there are no issues testing it and no need for the mom’s permission.”
- “It’s available immediately for 100% of births and needs only 1 collection by 1 collector,” saving time and money and getting quicker results than other specimens.
- “The detection window is up to approximately 20 weeks with extensive panel options including alcohol and heroin detection that is superior to any other newborn specimen on the market.” (USDTL)
Sure, we can also test the mother so that we can ensure she gets help – or at least that it’s offered! But, more importantly, why aren’t we addressing the lives of the most innocent victims when we have the tools available to do so?
Refer back to the beginning of this blog for that information!
References
https://www.cdc.gov/media/releases/2022/p0919-pregnancy-related-deaths.html
https://medlineplus.gov/ency/article/001597.htm#
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532701
Guided by Guida 
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